Mental health among older adults in Japan: do sources of social support and negative interaction make a difference?

This study addresses the question of whether social support and interpersonal strain from different sources (i.e., spouse, children, and other relatives and friends) have differential impact on mental health. Data for this research came from a national probability sample of 2200 persons aged 60 and over in Japan. Structural equation models were evaluated within the context of two types of social networks: (a) persons who had a spouse and children (n=1299), and (b) those with children only (n=677). Between these two networks, the links among social support, negative relations, and mental health were contrasted. The effects of various sources of social support and negative interactions on mental health vary depending on the specific dimension of mental health as well as the nature of social networks. Among older Japanese who are married with children, social support from spouse has a greater association with positive well-being than social support from children and others. However, cognitive functioning is uncorrelated with all sources of positive and negative social exchanges. In contrast, among those without a spouse, only greater support from children is significantly correlated with higher positive well-being, less distress, and less cognitive impairment.     

Economic evaluation of interventions for problem drinking and alcohol dependence: do within-family external effects make a difference?

AIMS: To propose methods for the inclusion of within-family external effects in clinical and economic evaluations. To demonstrate the extent of bias due to the exclusion of within-family external effects when measuring the relative performance of interventions for problem drinking and alcohol dependence. METHODS: The timing and magnitude of treatment effects are modified to accommodate the external health-related quality of life impact of having a problem or dependent drinker in the family home. RESULTS: The inclusion of within-family external effects reduces cost per QALY estimates of interventions for problem drinking and alcohol dependence thereby improving the performance of all evaluated interventions. In addition, the inclusion of within-family external effects improves the relative performance of interventions targeted at those with moderate-to-severe alcohol dependence as compared to interventions targeted at less severe alcohol problems. CONCLUSIONS: Failure to take account of external effects in clinical and economic evaluations results in an uneven playing field. Interventions with readily quantifiable health benefits (where social costs and benefits are predominantly comprised of private costs and benefits) are at a distinct advantage when competing for public funding against interventions with quantitatively important external effects.     

Widowhood and depressive symptoms among older Chinese: do gender and source of support make a difference?

In this study, we examined the effects of gender and pre-bereavement social support from three different sources (spouse, adult children, and friends) on widowhood adjustment among older adults in China. Hypotheses were developed by integrating the literature in the West and the cultural context of China. Data came from a panel survey, conducted in 1991 (baseline) and 1994 (follow-up), of a probability sample of older persons in Wuhan, China. For the present analysis, only those who were married with children at baseline were selected (N = 1,263). About 10% of the sample experienced spousal death between the two measurement points. Multiple regression analyses suggest that widowhood had a negative mental health consequence for older Chinese. Social support from adult children buffered the deleterious effect of widowhood, whereas spousal support during the marriage increased one's vulnerability. Support from friends was not found to have a significant effect. Gender difference in the effect of widowhood was also not evident. In this study, we have extended bereavement and social support research to a developing nation, with some findings similar to and some different from studies in Western developed nations.     

Are obese adolescents and young adults at higher risk for mental disorders? A community survey

OBJECTIVE: Associations between body mass index (BMI) and mental disorders meeting Axis-I diagnoses according to the Diagnostic and Statistical Manual for Mental Disorders IV (DSM-IV) were investigated in The Early Developmental Stages of Psychopathology Study in a large population-based sample, which included adolescents and young adults of both genders for the first time. RESEARCH METHODS AND PROCEDURES: A total of 3021 German subjects ranging from 14 to 24 years of age were assessed for specific DSM-IV diagnoses derived from a modified version of the standardized Composite International Diagnostic Interview, and general psychological disturbances, using the Symptom Checklist-90-Revised. BMI percentiles for age and gender were calculated to avoid systematic bias in the BMI distribution resulting from the young age range represented in the sample. Additionally, subjects with a lifetime diagnosis of any eating disorder were excluded from statistical analysis to control the confounding effect of body weight-related eating disorders on associations between BMI and psychopathology. RESULTS: The results based on logistic regression analyses and MANOVAs demonstrate that the BMI is not associated with mental disorders or general psychopathologies. There were no significant associations between BMI and mood, anxiety, substance, and somatoform disorders, a result that contrasts with almost all previous clinical studies. Additionally, in contrast to clinical investigations and most epidemiological studies, neither obesity nor underweight was significantly associated with any kind of general psychopathology. DISCUSSION: The overall finding that obesity is not significantly related to marked psychopathology in the general German population of adolescents and young adults has important clinical implications.     

How do eating disorders and alcohol use disorder influence each other?

OBJECTIVE: Although eating disorders and alcohol use disorder (AUD) are known to co-occur, the influence of one on the other has not been studied. METHOD: In a prospective study, women diagnosed with either anorexia nervosa (AN; n = 136) or bulimia nervosa (BN; n = 110) were interviewed and assessed for Research Diagnostic Criteria (RDC) AUD every 6-12 months over 8.6 years. RESULTS: Over one fourth of the sample (n = 66 [27%]) reported a lifetime history of AUD. Ten percent of the study subjects (n = 24) developed AUD over the course of the study. AUD did not influence recovery from either eating disorder. Poor psychosocial functioning and history of substance use predicted prospective onset of an episode of AUD for both diagnostic groups. Unique predictors for AUD for women with AN were depression, overconcern with body image, and vomiting. Recovery from AUD was predicted by group therapy and hospitalization (women with AN) and individual therapy and exercise (women with BN). CONCLUSION: The influence of eating disorders on AUD appears to be greater than the reverse. A substantial number of patients who initially present with an eating disorder develop alcohol problems over the course of time, suggesting that the risk is an ongoing one that should be monitored by clinicians.     

Modern contraception use in Ethiopia: does involving husbands make a difference?

OBJECTIVES. This study was undertaken to determine the relative efficacy of home visitation with and without husband participation on the use of modern contraception in Ethiopia. METHODS. A randomized field trial of a family planning education intervention using home visitation with and without husband participation was conducted in Addis Ababa, Ethiopia, from August 1990 to December 1991 and included a 12-month postintervention follow-up. A total of 266 experimental and 261 control subjects were entered, of whom 91.7% and 88.9%, respectively, were followed through 12 months. RESULTS. A greater proportion of couples in the experimental group were practicing modern contraception at 2 months (25% vs 15%) and 12 months (33% vs 17%) following the home visit intervention. By 12 months following the home visits, experimental subjects were less likely to have defaulted and more likely to have started using modern contraception following an initial delay. CONCLUSIONS. The inclusion of husbands in family planning programs will result in relevant increases in the use of modern contraception. However, there exists an important "sleeper" effect to the education intervention, reflected by a delay of greater than 2 months in the initiation of modern contraception for most couples.     

Where do teenagers and young adults receive treatment for cancer?

BACKGROUND: Little is known about where teenagers and young adults receive their first cancer treatment. METHOD: We extracted data on 2260 residents of southeast England diagnosed with a malignant neoplasm aged 10-24 between 1998 and 2002 from the Thames Cancer Registry database. We identified 11 cancer network areas of residence, and the hospital and network where each patient received their first chemotherapy treatment. We classified hospitals as those including paediatric oncology centres, cancer centres with a teenage cancer unit or adult cancer centres or units. We examined how many patients in each of the age groups 10-14, 15-19 and 20-24 travelled outside their network of residence for chemotherapy. RESULTS: Overall 45% (1018) received chemotherapy. Three networks had paediatric oncology centres, and one also had a teenage cancer unit. Most 10-14-year-olds were referred from their network of residence to networks with these services. However, there was an increasing tendency for patients aged 15-19 and 20-24 to be treated within their network of residence and to be referred less commonly. CONCLUSIONS: Many young people with cancer are not referred to services providing care tailored to the needs of their age group. The absence of any pattern to referral, despite the presence of a teenage cancer unit in the area, suggests a lack of coordinated referral practice within and between cancer networks.     

Support for tobacco control interventions: do country of origin and socioeconomic status make a difference?

Objective

To examine the attitudes to various tobacco control regulations among smokers from four different countries and explore differences by country and socioeconomic status.

Methods

Questions relating to tobacco regulation were asked of adult smokers from the 2007–2008 International Tobacco Control Four Country Survey (ITC4). Measures included attitudes to tobacco industry and product regulation, and measures of socioeconomic status and economic disadvantage.

Results

Overall smokers supported greater regulation of the tobacco industry with least supportive US smokers and most supportive Australian smokers. Reporting smoking-related deprivation and a lower income was independently associated with increased support for regulation of the tobacco industry (both p?≤?0.01).

Conclusions

Policy-makers interested in doing more to control tobacco should be reassured that, for the most part, they have the support of smokers, with greatest support in countries with the strongest regulations. Smokers economically disadvantaged by smoking were more supportive of government policies to regulate the tobacco industry suggesting that reactance against regulation is not likely to differentially contribute to lower cessation rates in this group.     

Liquor landscapes: Does access to alcohol outlets influence alcohol consumption in young adults?

Few longitudinal studies have examined the impact of liquor licences on alcohol consumption, and none in young adults, the life stage when alcohol intake is at its highest. We examined associations between liquor licences (i.e., general licences, on-premise licences, liquor stores, and club licences) and alcohol consumption at 20-years (n=988) and 22-years (n=893), and whether changes in the licences between time-points influenced alcohol consumption (n=665). Only general licences were associated with alcohol consumption at 20-years (p=0.037), but by 22-years, all licences types were positively associated with alcohol consumption (p<0.05). Longitudinal analyses showed that for each increase in liquor stores over time, alcohol consumption increased by 1.22 g/day or 8% (p=0.030), and for each additional club licence, consumption increased by 0.90 g/day or 6% (p=0.007). Limiting liquor licences could contribute to a reduction in young adults’ alcohol intake.     

Alternative approaches to derive disability weights in injuries: do they make a difference?

Background

In burden of disease studies, several approaches are used to assess disability weights, a scaling factor necessary to compute years lived with disability (YLD). The aim of this study was to quantify disability weights for injury consequences with two competing approaches, (a) standard QALY/DALY model (SQM) which derives disability weights from patient survey data and (b) the annual profile model (APM) which derives weights for the same patient data valued by a panel.

Methods

Disability weights were assessed using (a) EQ-5D data from a postal survey among 8,564 injury patients 2½, 5, and 9 months after attending the Emergency Department, and (b) preferences of 143 laymen elicited with the time trade-off method.

Results

Compared with APM, SQM disability weights were consistently higher. YLD calculated with SQM disability weights was more than three times higher compared with YLD calculated with APM disability weights, for mild injuries with short duration, this increase was six fold.

Conclusions

The APM seems the preferred method in burden of injury studies that includes mild conditions with a rapid course, since the SQM approach might overestimate the impact of the latter. The APM, however, might underestimate the impact of injury consequences, especially in case of severe injuries.     

Matching effects on eating: do individual differences make a difference?

Dyads composed of unacquainted females watched a video while snacking on pizza. Their extraversion and self-monitoring scores were used to predict the extent to which individuals within dyads matched each other's food intake. Matching of intake was high irrespective of the personality composition of the dyad. We consider elements of the situation that enhanced matching and whether personality might moderate matching effects.     

Type and timing of services following postnatal discharge: do they make a difference?

BACKGROUND: The debate continues as to what constitutes an adequate postnatal follow-up after an early hospital discharge. The main objective of this study was to determine whether the type and timing of postnatal services were associated with mothers' and newborns' health, breastfeeding duration, and maternal assessment of the delay and usefulness of the services they received after discharge. METHODS: A telephone survey was conducted one month after a vaginal, uncomplicated delivery by 2,583 mothers who had given birth in five health regions of the Province of Québec, between 1999 and 2003. RESULTS: The response rate to the survey was 72.1%. Virtually all the newborns (98.1%) had at least one routine contact with a health professional after discharge. Within 72 hours of discharge, 26.0% of the mothers received only a telephone call, 44.3% were visited by a public health nurse, 11.1% of the babies were examined by a physician and 49.5% were examined by a nurse or a physician. Newborns who had a first contact with a health professional within 72 hours of hospital discharge were less likely to have been readmitted to the hospital (adjusted Odds Ratio 0.45; 95% CI 0.21-0.97), while their mothers were less likely to have signs of moderate to severe depression at one month postpartum (adjusted Odds Ratio 0.60; 95% CI 0.45-0.79). The sooner the telephone call and the home visit were received the more likely the women were to have found that the services were useful. CONCLUSION: Our findings suggest that the timing, more than the type, of postnatal follow-up after an early obstetrical discharge could make a difference.     

Risk perceptions and behavioral intentions for Hepatitis B: how do young adults fare?

Young adults are at risk for Hepatitis B infection. Little is known about their attitudes and beliefs concerning Hepatitis B, which are determinants of getting immunized. This investigation examined risk perceptions and behavioral intentions concerning Hepatitis B among a convenience sample of 1070 young adults, 18-24 years old who participated in a Hepatitis B campaign that aired a prevention-based advertisement in movies. The campaign did not produce any significant effects. Therefore, analyses presented in this paper explored whether risk perceptions and intentions vary by sociodemographic characteristics. Most young adults do not perceive themselves to be at risk for Hepatitis B, but perceive other people to be at risk. Gender and ethnic differences in behavioral intentions to seek out Hepatitis B information were also observed. This study offers insight about important factors to consider when designing Hepatitis B prevention interventions for young adults and suggests that increasing health-promotion efforts for this group, while accounting for differences in age, culture and gender, are warranted.     

Food choices of young African-American and Latino adolescents: where do parents fit in?

To gain insight into parents' perceptions of the food preferences of their young adolescents, and their negotiating and decision-making strategies around food purchasing and meals, four focus groups were held with 32 African-American parents and three focus groups with 14 Spanish-dominant, first-generation immigrant Latina mothers. Most participants were of low socioeconomic status and were single parents. Many African-American parents emphasized children's growing appetites and preferences for fast food. Many reported making weekday dinner decisions jointly with the child or allowing the child to eat a lunch-like alternative, and allowing serve-yourself meals on weekends. A few prepared traditional ethnic foods. Latina parents reported that their children liked ethnic foods and fast/junk foods. They emphasized buying foods their children wanted, making no eating restrictions, and preparing traditional ethnic dinners without alternatives. African-American and Latina parents displayed concern over whether to place restrictions on young adolescents' eating. Further research is needed on the ways in which socioeconomic inequalities compound barriers to healthful eating, with particular attention to low income and immigrant populations.